| Subject | MultiPlan and Other Rental Networks: What Providers Need to Know |
| Source | Coding Corner May/June 2010 |
| Publication | Coding Corner May/June 2010 |
| Effective Date | Jun 1, 2010 |
| Publish Date | Jun 1, 2010 |
MultiPlan is essentially a group that partners with medical and dental payers to offer providers quicker payment in return for accepting discounted reimbursement rates. According to the company's web site (http://www.multiplan.com/index.cfm) their business is to deliver fast, accurate and quality claim repricing and negotiation services.
How it works is MultiPlan rents PPO networks and routes reimbursements from payers to physicians and hospitals. If a physician falls outside the network that a patient has accessed through MultiPlan, the doctor may receive a "fee negotiation agreement" or "expedited fee negotiation agreement" promising quicker reimbursement for a given service if the physician agrees to a lesser reimbursement rate. This typically means reimbursing a physician's services at the lowest contractual discounted rates the provider accepts from any individual payer. MultiPlan does not provide health benefit plans, administer plans, or provide health insurance, but rather serves as a secondary, or "rental" network used by larger insurers looking for discounts outside of their own networks. For more about rental networks and silent PPOs visit http://www.aaoms.org/pm_news.php?id=40.
Providers should be aware that they are not obligated to accept the terms of "fee negotiation agreements," or "expedited fee negotiation agreements" if they are not participating providers with the network. State prompt payment laws already require claims to be processed within a specified time frame, typically no more than 15 days following claim submission for an electronic claim and 30 days for a paper claim. Providers should check with their state OMS societies or Insurance Commissioner's Office for more information on the laws in their state.
Earlier this year, MultiPlan sent re-credentialing letters to the 60,000 providers appearing in their database. Many providers receiving these letters did not realize they were even affiliated with the network, in part due to the sometimes indirect nature in which providers become "contracted" with MultiPlan. Another reason cited was providers' not recognizing the "MultiPlan" name. In 2006 the company acquired Private Healthcare Systems (PHCS) with which providers may be more familiar.
Providers looking for additional information on MultiPlan's credentialing and recredentialing process and affiliation with providers may be interested in reviewing an information bulletin created by MultiPlan with input from the Connecticut State Medical Society (CSMS) and the American Medical Association (AMA). To view the bulletin visit http://www.ama-assn.org/ama1/pub/upload/mm/368/multiplan-recredentialing.pdf.